Maryland VA looks to private docs to speed up care

John Fritze and Matthew Hay Brown, The Baltimore Sun

The medical system charged with caring for Maryland's veterans is seeking help from private physicians in the Baltimore region to address a primary-care backlog that has become one of the worst in the nation, federal officials said Monday.

With Central Maryland's veterans waiting months to schedule an initial visit with a primary-care doctor, the Veterans Affairs Maryland Health Care System is hoping to tap into whatever reserve capacity is available in the area's extensive network of private clinics, according to a formal solicitation.

While the agency's move is unusual, it comes as lawmakers in Congress unveiled a bipartisan agreement Monday to spend $10 billion to expand access to medical care outside the traditional VA system for veterans who live more than 40 miles from a medical center or face long wait times.

"We want to make sure veterans have good access" to primary care, said Dr. Amit Khosla, deputy director of the managed-care clinical center for the VA system in Maryland. "We want to be proactive."

An audit released last month found that veterans in Maryland were waiting an average of 80 days to see a primary-care doctor for an initial visit, the fourth-longest wait in the nation. By comparison, wait times averaged 64 days in Atlanta, 60 days in Dallas and 59 days in Boston.

Khosla said the average wait in Maryland has since fallen to just under 76 days.

Veterans at a town hall meeting in Arbutus on Monday evening had mixed reactions to enlisting more private physicians to help with the VA caseload.

"That could help," said Robert Cisna, an 86-year-old Navy veteran from Arbutus. "The only thing I would be concerned about is the treatment that the veterans get. Some of these private doctors are going to get very, very rich."

The meeting was hosted by the American Legion, which is traveling the country to solicit veterans' concerns on the quality of care at their local VA medical centers.

Verna Jones, the legion's national director for veterans affairs and rehabilitation, said "purchased care is sometimes necessary," but "the VA should provide health care services for veterans."

"We are not an advocate of outsourcing VA health care," she said. "We believe the VA health care system is a system worth saving. … We don't want to tear it down. We want to build it up."

Lawmakers and the Obama administration have been scrambling to address problems at the agency after it acknowledged long wait times — and attempts by some employees to cover them up.

The scandal led to the ouster of VA Secretary Eric Shinseki in May. His likely replacement, Robert McDonald, is expected to be confirmed by the Senate on Tuesday.

It's not clear how much room is available at private primary-care clinics in the region, many of which already are overwhelmed. But Dr. Peter Beilenson, founder and CEO of Evergreen Health, said he was prepared to handle as many as 50 veterans a day in his network of four clinics located in the Interstate 95 corridor.

Beilenson, a former health official in Baltimore and Howard County, said his company would respond to the VA's request.

"We have the capacity to [offer] people same-day service," Beilenson said. "We want to be able to serve those who served the country."

Christopher J. Hardwick, a spokesman at the University of Maryland School of Medicine, said the Association of American Medical Colleges recently sent a request for medical schools willing to help the agency. The Maryland school, Hardwick said, "responded that we are willing to help with this request in any capacity and we have shared this response with the VA leadership."

The agency published its request for proposals late last week. Responses are due Aug. 11.

The wait times in Maryland prompted a June 17 visit from acting Secretary Sloan Gibson to the Baltimore VA Medical Center. At the time he pledged to spend $500,000 — a 40 percent increase — to help veterans facing delays seek private care.

The VA provides care for 55,000 patients in the state and by many other measures the agency has performed well. Patients already in the system wait an average of four days for a primary-care appointment, five days for an appointment with a specialist and about 21/2 days to see a mental health professional.

Veterans made more than 693,000 outpatient visits at Maryland VA facilities last year.

At American Legion Post 109 in Arbutus, 64-year-old Navy veteran Alan Hottinger spoke of waiting three months to secure a wellness appointment this month, not getting enough notice to get time off from work, and being told the next opening would be in another three months.

Lawmakers in Washington, meanwhile, unveiled a $17 billion proposal intended to shorten the time it takes to deliver care to veterans. Supporters say the House and Senate should be able to pass the legislation before Congress leaves for its August recess at the end of the week.

The agreement includes $10 billion in emergency funds to allow veterans to rely on outside doctors if they live more than 40 miles from a VA facility or are told they must wait more than 14 days for an appointment. An additional $5 billion would be used to hire doctors, nurses and other medical staff at VA facilities themselves.

"We have a VA that is in crisis today," said Rep. Jeff Miller, a Florida Republican who is the chairman of the House Committee on Veterans' Affairs. "This agreement will go a long way to helping resolve the crisis... helping to get veterans off of waiting lists is extremely important."

Sen. Bernie Sanders, the Vermont independent who chairs the Senate Committee on Veterans' Affairs, also backs the measure.

The proposal includes an independent committee to review VA operations and, in particular, to monitor how many veterans leave the VA system for private doctors.

"Funding for veterans' needs must be considered a cost of war," Sanders said.